Dr. Josephine Sommerville

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits after the insurer terminated them at the 104-week mark.

The insurer argued the applicant was not substantially disabled and had misrepresented his pre-accident income and post-accident earnings.

The arbitrator found the applicant's evidence regarding his symptoms and finances to be highly unreliable, noting deliberate misrepresentations.

However, objective medical evidence of a large disc herniation, materially related to the accident, established that he was physically incapable of returning to the essential duties of his pre-accident employment.

The arbitrator ordered ongoing income replacement benefits and granted a $10,000 special award because the insurer had unreasonably reduced benefits earlier in the claim based solely on the applicant's receipt of unemployment insurance.